The four years since 2010 have brought us a resurgence of antiabortion legislation, with hundreds of restrictions enacted at the state level. The guiding theory of this renewed anti-abortion activism is that abortion is the source of social ills, and that the way to end abortion is to make it illegal. Yet we know from long experience that criminalizing abortion neither ends the practice nor alleviates social ills. That, at any rate, is the timely and provocative lesson to be drawn from Nancy Howell Lee’s 1969 book, The Search for an Abortionist: The Classic Study of How American Women Coped With Unwanted Pregnancy, which was originally published by University of Chicago Press and was recently reissued by Forbidden Bookshelf, a division of Open Road Media.

A demographer and sociologist, Lee taught at the University of Toronto for 30 years; the book is based on her PhD dissertation, which she obtained from the Harvard University Department of Social Relations in 1968. Back then, Lee asserts, having an abortion was one of the most common form of illegal activity practiced in the U.S. Though the numbers are hard to specify, between 200,000 and 1 million women obtained abortions every year. Abortion was quiet, inconspicuous, and yet widespread. Howell Lee put flesh on these statistical bones by closely investigating the stories of 114 women who sought abortions.

In spite of the fact that the ‘60s was a time of loosening of sexual mores – the pill was first approved for prescription use in 1960 – there was an enormous amount of hypocrisy and subterfuge involved in the abortion trade, reflecting society’s continuing ambivalence toward women’s sexual autonomy. Lee describes the networks that allowed abortions to be carried out invisibly. “This description of how that system worked serves as an example of how complex societies manage their contradictions,” she writes.

Lee’s subjects spanned the spectrum of age, social class, and life circumstances. To assemble her data, Lee presented each one with a series of detailed questions: How did she locate their abortionist? Who did she enlist in her search, and how many people were involved in the referral? How much did the procedure cost, and how far did she have to travel to obtain it? What were her practitioner’s qualifications, and what type of procedure did they perform? Was it medically sound, and what was the aftermath?

Perhaps the most striking lesson of Lee’s research is how blind and random the process was. This was not just a matter of rich people getting what they wanted—a safe abortion—though that was certainly part of the story. Women’s success in terminating a pregnancy depended more on her social networks or even dumb luck. The extremely decentralized process of finding an abortionist made it difficult and time-consuming, says Lee: “Hundreds of thousands of times each year people manage this complicated procedure in the absence of institutional facilities to help them. One would think the sheer level of activity generated by so many people carrying out such a demanding task would make abortion a highly visible activity in the society. Yet outside certain circles, abortion is carried on almost invisibly.”

In our current era of aggressively transparent social networks, it is interesting to consider a time not so long ago when it was the invisible social networks that mattered most. Women confided in trusted friends, acquaintances, people they had heard about through the rumor mill, and with professionals with a lot of direct contact with the public, such as hairdressers and bartenders. Some subjects’ social networks led them swiftly to competent abortionists, while other subjects struggled for months.

The system of information transmission was chaotic and deeply inefficient: “One finds New York women flying to Puerto Rico to reach the only abortionist they learn about, while Puerto Rican women are flying to New York to follow up the leads they have found,” writes Lee. “Poor women sometimes put themselves deeply in debt to pay for expensive abortions, while wealthy women are sometimes unable to find the highly skilled practitioners they can afford to pay.” One woman even flew to Japan to obtain a safe, legal abortion, rather than take her chances on illegal channels in the U.S.

And where was the medical establishment in all of this? Aside from a handful of instances involving women of some economic privilege, it was largely unhelpful. Only six of the women were able to obtain legal, “therapeutic” abortions, largely by exaggerating distressed mental states. Nine others doctors gave their patients referrals to abortion providers who were believed to be competent. Some of the other doctors were sympathetic, but many were not. Notes Lee, “The only substantial source of complaints of rudeness, insults, or lack of sympathy from persons consulted during the search was doctors, and this was most often the woman’s own physician.”

The next obvious lesson we can draw is the consequence of such an opaque, clandestine process: the rate of unsafe, harmful procedures was alarming. About 20 per cent of the abortions were septic or incomplete, and about 10 per cent of the women required further hospitalization.

To paraphrase Tolstoy: each unhappy abortion story is unhappy in its own way. One woman handed over $650 to a driver who took her to a motel, where she was blindfolded. A “doctor” inserted a catheter, then left. The following day the woman had to go to the hospital where, for another $250, a D & C was performed. “With the best of intentions and considerable sophistication about how competent abortions are arranged,” Lee writes, the woman “ended up paying $900 for a particularly dangerous and frightening experience.”

Another subject was given a douche of some kind of hot solution. Within a few hours, she began to hemorrhage. Yet another reports that her abortionist, who was drunk at the time, injured her with surgical instruments. One reports that her abortionist made sexual suggestions while performing the procedure.

In spite of these traumatic experiences, the women still did not regret their decision to terminate the pregnancy. “I came out alive,” writes one, “and I was too grateful for that to think about it any more.”

Another woman, hospitalized after an unsuccessful attempt to terminate her own pregnancy at home, speaks of the “incredible humiliation and mental agony suffered during the entire affair, under the shadow, as well, of doing a so-called criminal act…although I have never been sorry to have rid myself of an unwanted child.”

In fact, a majority of the women report positive experiences with their abortionists. “In the absence of effective social control or professional control over the abortionists,” notes Lee, “it is striking how many of the women were relieved to find that they were treated well by a person they respected.”

The potential for physical harm during an illegal abortion leads into another, more subtle harmful effect: the psychological burden of negotiating a risky process without assistance and under expectation of silence. Women were expected to paper over the discomfort of others, paying the price for the duplicity of our sexual moral code.

One young woman was encouraged by her doctor to inform her parents of her situation. When she did so, they were furious.

“Why do we have this naïve belief that families will be better off if they face ‘the realities of life’?” she writes. “I knew perfectly well that my parents could not help me, but I wanted to do the right thing and it seemed like it at the time. All they really cared about when it came right down to it was that the neighbors shouldn’t find out.”

Lee’s book is 46 years old. But in light of the avalanche of restrictions on reproductive freedoms, it should be required reading now, in particular in those state legislatures where the health of women is once again under threat from the righteous hypocrisy of others.